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Third stage of labour


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third stage of labour,physiology and mangement

Third stage of labour

  2. 2. DEFINITION The third stage of labor lasts from the birth of the baby until the placenta is expelled. It is known as the placental stage of labour.
  3. 3. PHYSIOLOGICAL PROCESSES OF PLACENTAL SEPERATION AND EXPULSION Placental separation. Descend of the placenta. Expulsion of the placenta.
  4. 4. PLACENTAL SEPERATION result of the abrupt decrease in size of the uterine cavity . the retraction process accelerates. The formation of retro placental clot.
  5. 5. BEFORE SEPARATION Per abdomen: Uterus become discoid in shape, firm in feel and ballottable. Fundal height reaches slightly below the umbilicus. Per vaginum: There may be slight trickling of blood. Length of the umbilical cord as visible from outside remains static.
  6. 6. AFTER SEPARATION Per abdomen: Uterus become globular, firm and ballottable. fundal height is slightly raised. supra pubic bulging Per vaginum: Slight gush of vagina bleeding. Permanent lengthening of the cord.
  7. 7. DESCEND OF THE PLACENTA Sudden trickle or gush of blood. Lengthening of the umbilical cord. Change in the shape of the uterus, globular. Change in the position of the uterus.
  8. 8. EXPULSION OF THE PLACENTA The Schultz mechanism Mathew Duncan mechanism
  9. 9. HEMOSTASIS Retraction of the oblique uterine muscle fibres . vigorous uterine contraction following placental separation. transitory activation of the coagulation and fibrinolytic systems.
  10. 10. MANAGEMENT OF THIRD STAGE OF LABOUR Guard the uterus to keep yourself and anyone else from massaging it prior to placental separation. Do not massage the uterus before placental separation, except when partial separation has occurred by natural processes and excessive bleeding evident.
  11. 11. MANAGEMENT OF THIRD STAGE OF LABOUR Do not pull on the umbilical cord before the placenta separates or ever with an uncontracted uterus. Do not try to deliver the placenta prior to its complete separation unless in the emergency of third stage haemorrhage. Wait for the natural process to occur and do not interfere.
  12. 12. EXPECTANT MANGEMENT A hand is placed over the fundus to feel the signs of placental separation. the client asked to bear down simultaneously with the hardening of the uterus. If the placenta fails to expel, one can wait for upto 10 mts. soon as the placenta passes through the introitus, it is grasped by both hands and twisted round and round or slightly up and down with gentle traction .
  13. 13. EXPECTANT MANGEMENT  Controlled cord traction [ modified Brandt-Andrews method]:
  14. 14. EXPECTANT MANGEMENT EXPRESSION BY FUNDAL PRESSURE This is done by placing four fingers of the hand behind the fundus and thumb in front of the uterus to use as a piston. The uterus is made to contract by gentle rubbing. When the uterus becomes hard, it is pushed downwards and backwards. The pressure should be withdrawn as soon as the placenta passes through the introitus.
  15. 15. USE OF OXYTOCIC AGENTS Prophylactic use the administration of an oxytocic drug at the time of delivery of the anterior shoulder. Therapeutic administration This method implies the use of an oxytocic either to stop the bleeding once it has occurred or to maintain the uterus in a contracted state when there are indications that excessive bleeding is likely to occur.
  16. 16. FUNDAL HEIGHT DURING THIRD STAGE At the end of the third stage following the expulsion of the placenta, the fundus is about 4cm below the umbilicus.
  17. 17. COMPLETION OF THIRD STAGE Continuing evaluation ensure that the uterus is well contracted Slight lacerations are usually repaired immediately The vulva and perineum are gently cleansed mother’s blood pressure, pulse and temperature should be taken Once the mother is comfortable the placenta and membranes is the next priority
  18. 18. Examination of placenta and membrane Infarctions that are recent or old Localized calcifications Lobes Blood vessels Insertion of the cord Umbilical vessels Cord length Weight of placenta
  19. 19. care of newborn and mother care for at least an hour after delivery. The mother should receive cleansing body wash, mouthwash and perineal care. She should be encouraged to empty bladder and bedpan offered. Blood pressure, pulse, uterine contraction and bleeding should be checked every 15 mts.
  20. 20. care of newborn and mother The baby’s general wellbeing and security of the cord clamp needs to be checked. As the baby will chill after birth thoroughly dry and wrap the baby . Mothers intended to breastfeed may be encouraged. Early breastfeeding causes a reflex release of oxytocin from the posterior pituitary and stimulates the uterus to contract.
  21. 21. Records all the drugs administered, examination of the placenta, membranes and cord with attention drawn to any abnormalities and the amount of blood loss.
  22. 22. COMPLICATIONS OF THE THIRD STAGE Post partum haemorrhage. Hematoma formation. Retained placenta Inversion of uterus. shock
  23. 23. THANK YOU…….